PURPOSE:To determine the effect of acupressure on anxiety and sleep quality after cardiac surgery.

DESIGN:A randomized pre-post test control group design.

METHODS:Patients after cardiac surgery were divided into two groups: the intervention group (n = 50), who received acupressure on four different acupoints plus standard care, and the control group (n = 50), who received only standard care. Patients were admitted to the surgical clinic from the intensive care unit after 3 or 4 days of surgery. The levels of anxiety and sleep quality were evaluated during three postoperative days starting from their first day in the surgical clinic.

FINDINGS:Among the patients in the intervention group, the usage of acupressure decreased the level of anxiety and increased the sleep quality significantly compared with the control group (P<.05).

CONCLUSIONS:Our findings showed that acupressure decreased the level of anxiety and improved the sleep quality in the surgical clinic after cardiac surgery.

INTRODUCTION: In homeopathy ARNICA is widely used as a woundhealing medication and for the treatment of hematomas. OBJECTIVE: In this pilot study the efficacy and safety of ARNICA D12 in patients following varicose vein surgery were investigated. DESIGN: Prospective, randomized, double-blind, placebo-controlled pilot trial according to ICH GCP guidelines. SETTING: The study was conducted by a surgeon at the Angiosurgical Clinic, Berlin- Buch. INTERVENTION: After randomized allocation, 60 patients received either ARNICA D12 or placebo. Start of medication occurred the evening before operation with 5 globules. On the operation day one preoperative and hourly postoperative dosages after awakening were given. On days 2-14 of the study 5 globules 3 times a day were given. OUTCOME CRITERIA: Surface (in cm(2) and using a three-point verbal rating scale) and intensity of hematomas induced by operation, complications of wound healing, and intensity of pain (five-point verbal rating scale) as well as efficacy and safety of the study medication were assessed. RESULTS: Hematoma surface was reduced (from day 7 to day 14) under ARNICA by 75.5% and under placebo by 71.5% (p = 0.4726). The comparison of hematoma surface (small, medium, large) using the verbal rating scale yielded a value of p = 0.1260. Pain score decreased by 1.0 +/- 2.2 points under ARNICA and 0.3 +/- 0.8 points under placebo (p = 0.1977). Remission or improvement of pain was observed in 43.3% of patients in the ARNICA group and in 27.6% of patients in the placebo group. Tolerability was rated as very good in all cases. CONCLUSION: The results of this pilot study showed a trend towards a beneficial effect of ARNICA D12 with regard to reduction of hematoma and pain during the postoperative course. For a statistically significant proof of efficacy of ARNICA D12 in patients following varicose vein surgery a larger sample size is necessary. Copyright 2003 S. Karger GmbH, Freiburg

AIM: To evaluate the effect of bed rest with music on relaxation for patients who have undergone heart surgery on postoperative day one. BACKGROUND: Music intervention has been evaluated as an appropriate nursing intervention to reduce patients 'pain, stress and anxiety levels in several clinical settings, but its effectiveness in increasing patients' subjective and objective relaxation levels has not been examined. DESIGN: A randomised controlled trial. METHOD: Forty patients undergoing open coronary artery bypass grafting and/or aortic valve replacement surgery were randomly allocated to either music listening during bed rest (n = 20) or bed rest only (n = 20). Relaxation was assessed during bed rest the day after surgery by determining the plasma oxytocin, heart rate, mean arterial blood pressure, PaO2 SaO2 and subjective relaxation levels. RESULTS: In the music group, levels of oxytocin increased significantly in contrast to the control group for which the trend over time was negative i.e., decreasing values. Subjective relaxation levels increased significantly more and there were also a significant higher levels of PaO2 in the music group compared to the control group. There was no difference in mean arterial blood pressure, heart rate and SaO2 between the groups. CONCLUSION: Listening to music during bed rest after open-heart surgery has some effects on the relaxation system as regards s-oxytocin and subjective relaxations levels. This effect seems to have a causal relation from the psychological (music makes patients relaxed) to the physical (oxytocin release). RELEVANCE TO CLINICAL PRACTICE: Music intervention should be offered as an integral part of the multimodal regime administered to the patients that have undergone cardiovascular surgery. It is a supportive source that increases relaxation.

BACKGROUND AND OBJECTIVES: This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively. METHOD: Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients' postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers. RESULTS: There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L(-1) decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups. CONCLUSION: This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption.